One of the most important elements for running a successful ALF is having a strong team that is passionate about caring for seniors. It can be a difficult task to find these individuals due to the intense and oftentimes exhausting position of caring for seniors. As administrators, we must ensure these folks are trained adequately and given the tools to be successful at their job or we will not have a chance at retaining them for long. Check out the following regulation provided by the Maryland OHCQ as to what
type of staffing is required in your community:
.19 Other Staff — Qualifications.
A. The licensee shall employ or contract with sufficient numbers of other staff to ensure that the assisted living
program is capable of meeting the requirements of this chapter, and all other applicable laws and regulations, in a
manner consistent with the philosophy of assisted living and in compliance with generally accepted standards of
care for the specific conditions of the residents the assisted living program intends to serve.
B. Qualifications of Other Staff. At a minimum, all other staff shall:
(1) Be 18 years old or older unless licensed as a nurse or the age requirement is waived by the Department for
good cause shown;
(2) As evidenced by a physician’s statement be free from:
(a) Tuberculosis, measles, mumps, rubella, and varicella through appropriate screening procedures such as
tuberculosis skin tests, positive disease histories, or antibody serologies; and
(b) Any impairment which would hinder the performance of assigned responsibilities;
(3) Have no criminal convictions or criminal history that indicates behavior that is potentially harmful to
residents, as evidenced through a criminal background check completed within 30 days before employment;
(4) Have sufficient skills, education, training, and experience to serve the residents in a manner that is
consistent with the philosophy of assisted living;
(5) Participate in an orientation program and ongoing training to ensure that the residents receive services that
are consistent with their needs and generally accepted standards of care for the specific conditions of those residents
to whom staff will provide services;
(6) Receive initial and annual training in:
(a) Fire and life safety, including the use of fire extinguishers;
(b) Infection control, including standard precautions, contact precautions, and hand hygiene;
(c) Basic food safety;(d) Emergency disaster plans; and
(e) Basic first aid by a certified first aid instructor;
(7) Have training or experience in:
(a) The health and psychosocial needs of the population being served as appropriate to their job
responsibilities;
(b) The resident assessment process;
(c) The use of service plans; and
(d) Resident’s rights; and
(8) Hold appropriate licensure or certification as required by law.
C. With the exception of certified nursing assistants (CNAs) and geriatric nursing assistants (GNAs), if job duties
involve the provision of personal care services as described in Regulation .28D of this chapter, an employee:
(1) Shall demonstrate competence to the delegating nurse before performing these services; and
(2) May work for 7 days before demonstrating to the delegating nurse that they have the competency to provide
these services, if the employee is performing tasks accompanied by:
(a) A certified nursing assistant;
(b) A geriatric nursing assistant; or
(c) An individual who has been approved by the delegating nurse.
D. Basic CPR training shall be provided on an initial and ongoing basis to a sufficient number of staff by a
certified CPR instructor to ensure that a trained staff member is available to perform CPR in a timely manner, 24
hours a day.
E. Relief personnel shall be available at all times in the event that the regularly scheduled staff members are
unavailable. Relief personnel shall meet the requirements of §B of this regulation.
F. Proof of training shall include:
(1) Date of class;
(2) Course content;
(3) Documentation of successful completion of the training content;
(4) Signatures of the trainer and attendees; and
(5) Qualifications and contact information for the trainer.
G. Training in Cognitive Impairment and Mental Illness.(1) When job duties involve the provision of personal care services as described in Regulation .28D of this
chapter, employees shall receive a minimum of 5 hours of training on cognitive impairment and mental illness
within the first 90 days of employment.
(2) The training shall be designed to meet the specific needs of the program’s population as determined by the
assisted living manager including the following as appropriate:
(a) An overview of the following:
(i) A description of normal aging and conditions causing cognitive impairment;
(ii) A description of normal aging and conditions causing mental illness;
(iii) Risk factors for cognitive impairment;
(iv) Risk factors for mental illness;
(v) Health conditions that affect cognitive impairment;
(vi) Health conditions that affect mental illness;
(vii) Early identification of and intervention for cognitive impairment;
(viii) Early identification of and intervention for mental illness; and
(ix) Procedures for reporting cognitive, behavioral, and mood changes;
(b) Effective communication including:
(i) The effect of cognitive impairment on expressive and receptive communication;
(ii) The effect of mental illness on expressive and receptive communication;
(iii) Effective verbal, nonverbal, tone and volume of voice, and word choice techniques; and
(iv) Environmental stimuli and influences on communication;
(c) Behavioral intervention including:
(i) Identifying and interpreting behavioral symptoms;
(ii) Problem solving for appropriate intervention;
(iii) Risk factors and safety precautions to protect the individual and other residents; and
(iv) De-escalation techniques;
(d) Making activities meaningful including:
(i) Understanding the therapeutic role of activities;(ii) Creating opportunities for productive, leisure, and self-care activities; and
(iii) Structuring the day;
(e) Staff and family interaction including:
(i) Building a partnership for goal-directed care;
(ii) Understanding families needs; and
(iii) Effective communication between family and staff;
(f) End of life care including:
(i) Pain management;
(ii) Providing comfort and dignity; and
(iii) Supporting the family; and
(g) Managing staff stress including:
(i) Understanding the impact of stress on job performance, staff relations, and overall facility environment;
(ii) Identification of stress triggers;
(iii) Self-care skills;
(iv) De-escalation techniques; and
(v) Devising support systems and action plans.
(3) When job duties do not involve the provision of personal care services as described in Regulation .28D of
this chapter, employees shall receive a minimum of 2 hours of training on cognitive impairment and mental illness
within the first 90 days of employment. The training shall include:
(a) An overview of the following:
(i) A description of normal aging and conditions causing cognitive impairment;
(ii) A description of normal aging and conditions causing mental illness;
(iii) Risk factors for cognitive impairment;
(iv) Risk factors for mental illness;
(v) Health conditions that affect cognitive impairment;
(vi) Health conditions that affect mental illness;
(vii) Early identification and intervention for cognitive impairment;(viii) Early identification and intervention for mental illness; and
(ix) Procedures for reporting cognitive, behavioral, and mood changes;
(b) Effective communication including:
(i) The effect of cognitive impairment on expressive and receptive communication;
(ii) The effect of mental illness on expressive and receptive communication;
(iii) Effective verbal, nonverbal, tone and volume of voice, and word choice techniques; and
(iv) Environmental stimuli and influences on communication; and
(c) Behavioral intervention including risk factors and safety precautions to protect the individual and other
residents.
(4) Ongoing training in cognitive impairment and mental illness shall be provided annually consisting of, at a
minimum:
(a) 2 hours for employees whose job duties involve the provision of personal care services as described in
Regulation .28D of this chapter; and
(b) 1 hour for employees whose job duties do not involve the provision of personal care services as described
in Regulation .28D of this chapter.
H. The training that is described in §F of this chapter may be provided through various means including:
(1) Classroom instruction;
(2) In-service training;
(3) Internet courses;
(4) Correspondence courses;
(5) Prerecorded training; or
(6) Other training methods.
I. When the training method does not involve direct interaction between faculty and participant, the assisted living
the program shall make available to the participant during the training a trained individual to answer questions and
respond to issues raised by the training.
Pro Tip:
One of the most common deficiencies seen during the survey of an Assisted Living Facility is the failure
to train (or keep a record of training) employees along with properly documenting the paperwork
required to be employed in the facility. Ensure you have a point person who is responsible for collecting
and organizing all the staff training at both the time of orientation and all annual education. As the
administrator, you should play a key role in identifying the compliance of your staff training files.